Ch 11: Physician Medical Billing

The boxes on the CMS-1500 and UB-04 claim forms are also called these.

5.

Signed by the patient, allows the provider to release information to a specified party

8.

A claim that contains all necessary and valid data elements

9.

The form used to bill an outpatient claim

12.

feedback from the insurance company or clearinghouse indicating changes that need to be made to claims

13.

The claim form used to bill inpatient insurance claims

14.

A rule that determines the primary insurance based off of the parent's dates of birth

15.

Determining which insurance is primary and which is secondary

16.

Making sure that the patient's indurance is active and that the services will be covered

17.

A number that is used to identify the provider as well as for tax purposes

Down

2.

The artificial eye that reads the information on the paper claim forms

3.

The insurance that will pay second on a claim, after the primary insurance has paid.

4.

A claim that is invalid or missing necessary information

6.

Process of scrambling information during elecrtonic claims processing

7.

Request made by a patient to allow the insurance company to pay the provider for the claim.

10.

The person who holds the insurance coverage, also called the subscriber

11.

Also known as an encounter form, used to record the encounter between the provider and the patient.

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